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Reproductive Health Matters
An international journal on sexual and reproductive health and rights
Volume 21, 2013 - Issue 42: New development paradigms for health, SRHR and gender equity
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Original Articles

Reproductive health financing in Kenya: an analysis of national commitments, donor assistance, and the resources tracking process

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Pages 139-150 | Published online: 04 Dec 2013
 

Abstract

Understanding the flow of resources at the country level to reproductive health is essential for effective financing of this key component of health. This paper gives a comprehensive picture of the allocation of resources for reproductive health in Kenya and the challenges faced in the resource-tracking process. Data are drawn from Kenyan budget estimates, reproductive health accounts, and the Resource Flows Project database and compare budgets and spending in 2005–06 with 2009–10. Despite policies and programmes in place since 1994, services for family planning, maternity care and infant and child health face serious challenges. As regards health financing, the government spends less than the average in sub-Saharan Africa, while donor assistance and out-of-pocket expenditure for health are high. Donor assistance to Kenya has increased over the years, but the percentage of funds devoted to reproductive health is lower than it was in 2005. We recommend an increase in the budget and spending for reproductive health in order to achieve MDG targets on maternal mortality and universal access to reproductive health in Kenya. Safety nets for the poor are also needed to reduce the burden of spending by households. Lastly, we recommend the generation of more comprehensive reproductive health accounts on a regular basis.

Résumé

Pour financer efficacement la santé génésique, il est essentiel de comprendre le flux de ressources destinées, au niveau national, à cet élément clé de la santé. L’article brosse un tableau complet de l’allocation de ressources à la santé génésique au Kenya et les difficultés rencontrées dans le suivi des fonds. Les données sont tirées des estimations budgétaires kényanes, des comptes de la santé génésique et de la base de données sur le projet de flux de ressources. L’article compare les budgets et les dépenses de 2005–06 avec 2009–10. Bien que des politiques et programmes soient en place depuis 1994, les services de planification familiale, de soins maternels et de santé juvéno-infantile se heurtent à de sérieux écueils. S’agissant du financement de la santé, le Gouvernement dépense moins que la moyenne en Afrique subsaharienne, alors que l’assistance des donateurs et la participation des patients aux frais de santé sont élevées. L’aide des donateurs au Kenya a augmenté au fil des années, mais le pourcentage de fonds consacré à la santé génésique est inférieur à son niveau de 2005. Nous recommandons de relever le budget et les dépenses de santé génésique afin de réaliser les OMD sur la mortalité maternelle et l’accès généralisé à la santé génésique au Kenya. Des filets de sécurité pour les pauvres sont aussi requis afin de réduire la charge financière des ménages. Enfin, nous préconisons de créer régulièrement des comptes de santé génésique plus complets.

Resumen

Entender el flujo de recursos a nivel nacional en el área de salud reproductiva es esencial para la financiación eficaz de este elemento fundamental para la salud. En este artículo se ofrece una visión integral de la asignación de recursos para salud reproductiva en Kenia y los retos en el proceso de dar seguimiento a los recusos. Se obtuvieron datos de estimaciones presupuestarias, cuentas de salud reproductiva y la base de datos del Proyecto del Flujo de Recursos, y se compararon los presupuestos y los gastos en 2005–06 con los del 2009–10. A pesar de políticas y programas establecidos desde 1994, los servicios de planificación familiar, atención materna y salud de lactantes y de niños enfrentan retos difíciles. En la financiación de servicios de salud, el gobierno gasta menos del promedio en Ãfrica subsahariana, mientras que la asistencia de donantes y desembolsos varios para la salud son altos. En los últimos años, los donantes han aumentado su ayuda financiera a Kenia, pero el porcentaje de fondos dedicados a la salud reproductiva es menor que en 2005. Recomendamos un aumento en el presupuesto y los gastos en salud reproductiva a fin de lograr las metas de los ODM respecto a la mortalidad materna y el acceso universal a servicios de salud reproductiva en Kenia. Además, es necesario proteger a la gente pobre reduciendo la carga de gastos por vivienda. Por último, recomendamos generar con regularidad cuentas más integrales de salud reproductiva.

Acknowledgments

The study is part of the Resource Flows Project run in collaboration between UNFPA, the Netherlands Interdisciplinary Demographic Institute and the African Population and Health Research Centre. The aim of the Resource Flows project is to monitor global financial flows for population and HIV/AIDS activities, and to strengthen the institutionalization of country-owned systems to produce periodic reports that compare the need for sexual and reproductive health funding at country level with the allocation of resources (domestic and external). The views expressed in this paper do not necessarily reflect the views of UNFPA, NIDI or APHRC.

Notes

* Households, for instance, paid for 29% of health care in 2009–10 but channelled only 19.3% directly to providers; this is because their money is not necessarily paid directly to the providers but through public or private insurance funds.

* In April 2001, African Union countries meeting in Abuja, Nigeria, pledged to increase government funding for health to at least 15%, and urged donor countries to scale up support. http://www.who.int/healthsystems/publications/abuja_report_aug_2011.pdf.

† Recent meetings included the International Family Planning Conferences in 2009 in Kampala, 2011 in Dakar, and 2012 in London, which attracted large audiences from around the world uniting global leaders around new funding commitments.

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